The Structuration of Goals in a Healthcare Setting: A Case Study Examining the Social Structuring Interactions Between Organizational Context and Knowledgeable Agents Open Access
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This case study researched cross-level goals as structuring mechanisms in a healthcare setting, and the social structuring interactions between knowledgeable agents and organizational context. Stones' (2005) strong structuration theory was used as the theoretical framework in order to investigate external and internal structures and active agency. The research site was a home healthcare unit of a large, metropolitan hospital system. Data was collected through observations, documents and interviews with the site's executive team and mid-level managers who were assigned performance goals derived from organizational-level strategy and who served as the study's main agents-in-situ. The study identified the organizational contextual features that shaped the relationship between cross-level performance goals, and presented findings related to the outcomes of the interactions between contextual features and internal structures of individuals. Stones' (2005) methodological bracketing approach guided the data collection and analysis. The interactions between the internal structures of the managers and the organizational contextual features revealed three specific interactions--the structuring of individual perception and acceptance of goals, role tension in the formal manager position and a mixed effect of performance rewards--as well as two patterns of behavior of transparency and flexibility/negotiation. These five primary interactions related to active agency resulted in two re-shaped external structures, a re-shaped goal and a re-shaped perception of the formal positions in the case study site. This study demonstrated that knowledgeable actors influence the structuration of cross-level goals through interactions with the situated context of their daily organizational life. Both emergent and contextual effects were seen in this case, and this underscores that multilevel analysis is relevant to understanding how goals operate in a recursive relationship with individuals in specific organizational contexts.